Legitimacy and Geriatrics: Making Space for Geriatric Care in a National Healthcare System

TL;DR

This study explores how geriatric care is supported in the U.S. Veterans Health Administration, focusing on challenges and strategies for rural Veterans.

Contribution

The paper extends the concept of biomedical legitimacy to examine how national healthcare systems shape geriatric service availability.

Findings

Leadership support and clinician availability are key facilitators for geriatric care implementation.

Systemic and logistical factors significantly influence the delivery of geriatric services.

Contextual challenges highlight the need for improved pathways to support aging Veterans.

Abstract

This presentation uses the lens of medical anthropology to better understand how geriatric services are established and maintained within the Veterans Health Administration (VHA) system. Specifically, we look to Margaret Locks theoretical concept of ‘biomedical legitimacy’ in biomedicine to examine the challenges and strategies involved in implementing and maintaining geriatric programs aimed at serving rural Veterans within a complex healthcare landscape. Particularly we build on Lock’s biomedical legitimacy concept by considering how contextual factors, within a national healthcare system setting, influence the availability of geriatric services. We conducted semi-structured interviews with 13 staff members from four VA Clinical Resource Hubs (including a range of professional backgrounds such as psychiatry, family medicine, and geriatrics) and 11 former national, regional, and facility leaders in the VHA representing over 250 cumulative years of experience. Data were initially analyzed through team-based rapid qualitative analysis and then examined using the construct of “legitimacy.” Some of the findings include facilitators and barriers staff experienced while advocating for geriatric care as part of their region’s service line, some of which included leadership support and availability of clinicians to provide specialized geriatric care. This analysis provides a broader understanding of the systemic and logistical considerations that impact the delivery of geriatric care and highlights potential pathways for strengthening support for aging Veterans within the VA system and beyond.